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11050235CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22679 WEEPING OAK CT CONTRACTOR: DRAEGER PERMIT NO: 11050235 CONSTRUCTION INC OWNER'S NAME: YOUNGBAE & JIYEON KIM 605 COMMERCIAL ST DATE ISSUED: 08/22/2011 OWNER'S PHONE: SAN JOSE, CA 95112 PHONE NO: (408)536-0420 ❑ LICENSED CONTRACTOR'S DECLARATIONF_ BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class (,*'— Lic. # f— F_ F_ MECH RESIDENTIAL COMMERCIAL Contractor (G7 ' '-�f/'l Date l JOB DESCRIPTION: RE-ROOF 10 SQ- 1/2"PLYWOOD, TPO OVERLAY WITH-2 1 hereby affirm that I am licensed under the provisions of Chapter 9 LAYER FR-10 BARRIER (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $375 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 34232036.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the wor which this permit is issued APPLICANT CER'T'IFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save N. 180 DAY FROM LAST CALLED INwrl indemnify and keep harmless the City of Cu o against liabilities, judgments, costs. and expenses which may accrue a nst sai' City in consequence of the Issued by: Date: ,,ranting of this permit. Additionall ie appli ant un rids and will comply with all non-point source regulat is per th uper o Mu icipal Code, Section 9 18. � �S. ` RE-ROOFS: Signature ate All roofs shall be inspected prior to any roofin aterial being installed. If a roof is installed without first obtaining an inspec ' I ree to r ve all new materials for inspection. ❑ OWNER-BUILDER DECLARATION s- Signature of Applicant: ate: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER L as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I. as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should 1 use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Code, Sections 25505, 25533, 255 I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this/- the Health & Safety and Owner or authorized agenttb�1 �! �( �S Date: permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmfless the City oCupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature __ Date 3 ITEMS OF 15 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34232036.00 DATE ISSUED.......: 08/22/2011 RECEIPT #......... BS000014522 REFERENCE ID # ...: 11050235 SITE ADDRESS .....: 22679 WEEPING OAK CT SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OWNER YOUNGBAE & JIYEON KIM ADDRESS 22679 WEEPING OAK CT CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: SylviaM COPY # : 1 RECEIVED FROM ....: DRAEGER CONST. CONTRACTOR .......: DRAEGER, JOHN EDWARD LIC # 21895 COMPANY ..........: DRAEGER CONSTRUCTION INC ADDRESS ..........: 605 COMMERCIAL ST CITY/STATE/ZIP ...: SAN JOSE, CA 95112 TELEPHONE ........: (408)536-0420 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ----------------------- 1BCBSC VALUATION ---------- 375.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 375.00 0.50 0.00 0.50 0.00 1REROOFRES SQ FEET 10.00 140.00 0.00 140.00 0.00 ---------- TOTAL PERMIT ---------- 141.50 ---------- 0.00 ---------- 141.50 0.00 VOICE ID DESCRIPTION -------- ---------------------------- 309 EXTERIOR LATH 601 ROOF TEAR OFF VOICE ID DESCRIPTION -------- ---------------------------- 311 SCRATCH COAT 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF CUPERTINO REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingacupertino.org �'I jn rl I 10562,35� y (04 a • APN# PvnTrrr.i,nvrcc C p O .... G' i (� O /) I, i� 7 PH E , ., f E-MAIL STREET ADDRESS STA v FAx 2 0 -e Mr PHONE E MAIL r)JA �l y STREES P� S� STATE ZIP 7' CT_ FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT 52�CONTRACrOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT C C QRNAIvIELI CA, NUMB LI�EN$�TYPE BUS. LIC.# (X lo ` 5 COMP��Aj.QE V � yG / /O E-MAIL FAX STR. ETA /}�8� Q{� l C , STATE 1 l KC �� , !'`r/l \-'/ / ARCHITEECT/ENGII�ER NAME LICENSE BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF FD or Duplex ❑ Multi -Family ROOF AREA: v S V.eT 7TA-Mnwr.2/��(j. 90 ❑ Commercial / 2- F� STRUCTURE: �'1/ 1 �/I4` EXISTING ROOF TYPE: UILT-UP ROOF ❑ ASPHALT SHINGLES ElWOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY) REMOVE /REPLACE ❑ YES IF NO. PLYWOOD /� h" ❑ 7PLYWD ❑ OSB PITCH: ROOF O # LAYER I-rIICKNESS: ❑ 5/8" TYPE: Ea CDX ' 12 CLASS: A PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ;90TER ICC -ES REPORT # DESCRIPTION OF WORK: r all 2 •�� /� leg By my signature below, I certify to each of the followi . I am property owner or autho ' ent to act on the property owner's behalf. I ve read this application and the information I have provided i ect. I e rmd the Description ork and erify it is accurate. I agree t comply all applicable local ordinances and state laws relating to buildin ction autho ' sentati of Cupertin tc enter the abov -'den ' le pp pew; f inspection purposes. purposes. Signature of Applicant/Agent: Date: li C SUPPLEMENTAL TION REQUIRED '— _ If building is associated with a Home Owner's Association, provide letter �'�E3iouT�lia sl��F OL'F— v>rR TAF-�r�l •�R M13 DINGPIAN-RE1'dEW of approval from HOA. ..s'y^a'.` — Provide Planning approval to verify if there any restrictions. 3�. - r� II;�gSS ps+'�c.r..Sy- r PL7►7vrrBGPLANREVIEW Provide. copy of Manufacturer's Installation Specifications. t� :,,V��ovide Cupertino's Tear 7.7 signed copy of -Off Policy. ..mac ReroofApp 2011.doc revised 03/02/11